| NPI | 1801517719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 315208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 315208) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2023-07-22 |